Today’s podcast episode is with Cash-Based Practice Owner, Carlos Berio PT, DPT, MS, CSCS, CMTPT. He employs a staff physical therapist, a personal trainer, and an office administrator. He shares multiple lessons he’s learned along the way and the key factors to his success so far.

In this episode, you’ll learn about:

How Carlos got his start in the cash-pay realm and went from a 300 sq ft space to a 2000 sq ft space.

The mistakes he made along the way.

The compensation plan he has for his cash-based employees.

His emphasis on Value and how his team emphasizes this to their clientele.

The logistics of out-of-network PT billing on behalf of cash-pay patients.

The variety of non-treatment wellness and fitness services he offers and how he markets them.

His “soft-discharge” approach and PT “tune up” program.

His advice for those interested in this business model but worried about the ability to grow a practice beyond one or two practitioners.

Thanks for the comment. I’m glad when I can encourage my colleagues into delivery of the high value service we’re capable of.

I’m not sure I mentioned specifics of session types or costs in the podcast. We charge $175 for eval and $145 for subsequent Rx’s. We also offer a short rx option (case dependent) at $89. Training rates range from $79-$99/hour. There are other services with different price points but these are the most commonly billed and practiced services here.

I love your clinic model and thanks for offering your insight on the podcast.

I have recently started a PT practice with a similar model, but I have actually started it out of a custom-built cargo trailer that I have designed to be a mobile PT clinic. The original idea was to set-up in a food trailer park (they are popular here in Austin and I figured would make PT accessible to the general population) and also to travel to various events and business venues. I was set up for about 3 months at a particular location but couldn’t make the finances make sense for me to be there and feel like the property was poorly managed. Most of my business came from referrals from a MT, not from walk-up consultations like I had planned. Now, my main focus is doing events, seeing people in the clinic as it is set up in my backyard and also to travel to clients’ houses and perform home-visits (or park visits depending on the level of treatment/training needed). I have bigger long-term plans but this is how I am choosing to grow my business in a somewhat affordable way.

My main issue is marketing to MD’s because 1) my practice is cash-based and 2) is based out of a trailer. Do you market to MD’s and if so, how? How do you get most of your business?

Your model definitely sounds like it fits one of the most important rules and that is to keep your overhead low. While I don’t know the specifics of a set up like your I’m sure it’s less costly than a “regular” brick and mortar set up. Plus the ‘gimmick’ of the special mobility you provide could open up other very cool opportunities.

To answer your questions:
1) No. While we like to network with MDs, we do not spend any real marketing dollars or energy on them. Generally speaking, from my experience (Oh, how I hate that phrase in our evidence informed practice models, but that’s another story by itself!), it’s simply not worth the time. As a cash practice we are so far removed from the oppressive thumb of the third party payer that I feel any energy perpetuating the “hierarchy” of physician TO physical therapist is not productive for our discipline OR for pt outcomes. Physicians are important. They do work that we cannot. That said, we do work that THEY cannot and our “toolbox” is far more vast. Just think about it, why do we continue to ask permission to do the work that we are expertly trained in? We need them to be in the loop in some capacity, that is true. Most of the relationships we develop with MDs comes from people who see us in a direct access capacity AFTER they have been seen in PT Mill somewhere and seen poor or no benefit (Mill care at it’s best). That pt does some research to find that they do have a choice in their conservative care, then when we do our work, word goes back to their doc. Most of our pts are happy for having seen the outcomes they wanted and send glowing reports back to their MDs; So what you think happens after that???

NOTHING!! That MD, even after hearing that a better solution is out there for their pts, does NOTHING different. They continue to refer to the Mill that just bought their office lunch or that they can somehow receive some benefit for the referral, whether via branding or outright ownership. It’s not fair, but it’s the truth. It happens all of the time and until we stop trying to seek their approval or relationship, it will continue to happen.

We focus ALL of our energy on local groups that share our vision for real progress, intense focus on outcomes and improving movement through our skills. Amateur athletic organizations, local schools, athletes and our current pts have lifted our census to heights that we could only have dreamed. In just over 5 years we are at a level that I can finally say is “consistent enough” to sustain our growth and allow us to work in the most rewarding way.

Apologies for my tone but this is an area where I’ve lost most of my patience for our “allies” in the ivory tower.

Whoa! Thanks. I love the way you stated this and helped me to avoid wasting time and money on a potentially fruitless strategy.

I would love for PT to eventually be the 1st line of defense that people think of when they have an injury or impairment. The current mindset of the general population puts us in 3rd or 4th in that regard when I feel like we should be the 1st reference point. I am hoping that my practice further progresses the knowledge and awareness of the general population toward our profession, knowledge and expertise.